Comorbidity between enuresis and attention deficit hyperactivity disorder: a case-control study

Background Although there is a strong association between enuresis and psychopathology, little is known about the prevalence of specific psychiatric disorders. We investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in children with enuresis and study the impact on child behavior, self-esteem, and different EEG findings. A total number of one hundred 6 to 12 years old children diagnosed as functional enuresis taken from specialized university setting for enuresis at Mansoura Pediatric Outpatient Clinic, in which they could be subdivided into 2 groups after assessment of attention deficit hyperactivity disorder (ADHD); according to DSM-IV criteria, we also compare them with a third ADHD group taken from Mansoura Psychiatric Outpatient Clinic n = 40 to match the co-morbid “enuresis with ADHD” group. All were subjected to a diagnostic interview conducted and completed with parents and developmental and family history as well, also they subjected to Conner’s parent rating scale-93(CPRS-93), Rosenberg self-esteem assessment scale, and EEG examination. Results There was high prevalence of ADHD in our study with about 40% in children with enuresis especially who met the DSM–IV criteria of inattention attending a specialized setting for enuresis at Mansoura Pediatric Outpatient Clinic which is a tertiary setting where the older the children of enuresis, the higher the prevalence of ADHD, also there is a relationship between abnormal epileptiform discharge in EEG finding and enuresis as same as ADHD which became greatly increased in the children who had both disorders who was the most affected group as regard behavioral problems and lowered self-esteem levels. Conclusions The strong association between ADHD and enuresis suggests that the presence of enuresis should motivate diagnostic assessment of ADHD especially the inattentive subtype. Abnormal EEG finding in the form of generalized slow and sharp waves may be useful as a predictor for the presence of ADHD in children with enuresis. Also, the co-morbidity increases the negative impact on child behavior and self-esteem.